Rutinas de Pensamiento.

PROVIDER: Good morning, Philip. My name is Anthony. I am Alaska Native and have been working at this treatment facility for the last year. My family and I come from a remote village located in the Arctic Slope region; most of my family still lives there. I want to thank you for seeing me today. An outreach worker brought you in two nights ago, and I’d like to spend some time talking about your situation. Is that okay with you? [Philip nods.]

MASTER PROVIDER NOTE

In counseling strategies that focus on building relationships, including MI, it is good practice to ask permission when introducing a set of questions or before providing suggestions.

PROVIDER: What would be important for me to know about you or your situation right now?

PHILIP: I’m in pretty bad shape right now. I needed “three hots and a cot” and didn’t want to go to a city program. They don’t say good things about us. I’ve been camping, and we had to move several times because police would come to check on us or try to get us into a program. I was getting tired and wanted to get out of the cold. [Some silence.]

PROVIDER: You’re not sure about your decision to come here, even though you want to get out of the cold and sober up. [Philip nods yes.]

PHILIP: I thought coming to a city would bring in some money. It didn’t happen that way. After staying with some friends, I felt as if I was a burden and needed to get out. I’ve been drinking more now than I ever did.

PROVIDER: So, it’s more than three hots and a cot; the alcohol was getting to you.

PHILIP: Not sure what happened. I’ve had bad times before, but if the booze is around—I drink it. I guess I always did.

PROVIDER: Was there ever a time when you didn’t drink it, even if it was around?

PHILIP: When I lived with my grandparents and my sister’s family. I respected them, and they are the few people I know who don’t drink in my village. My grandparents always say, it is White man’s poison. I’m beginning to believe it. Sometimes I feel possessed. It controls me. [Philip begins to look very uneasy or anxious. He starts looking at the door.]

PROVIDER: Can I ask you what just happened? Are you feeling okay? [From the provider’s perspective, Philip has started looking pale and uncomfortable.]

PHILIP: I got to get out of here.

PROVIDER: Do you mean that you need to leave this room or leave the detoxification center? [No

response.] Philip, do you want to stand outside?

[He replies, “Yes.” They both go outside and stand together. Some time passes before there is an

exchange.] How’s this?

PHILIP: Feels better. [Pause.] Sometimes I just have to get up and walk. [Philip and the provider talk briefly about how this can be done while he is finishing up detoxification.]

PROVIDER: [Still outside.] Philip, can I ask you another question? [He nods.] How has alcohol possessed you?

PHILIP: I’ve drunk when I didn’t want to drink or I promised myself that I wouldn’t drink. I’ve done things that I would never do if I didn’t drink. Sometimes, I think I left my grandparents and family because of it. I couldn’t be around them and drink. The drink pulls me to another world.

[Philip gestures that it’s good to go back inside.] It’s getting cold.

PROVIDER: [They begin walking back to the

office.] Philip, I can see that alcohol has caused you

many losses, and from what you say, it’s robbed you of your family and support.

PHILIP: [Some time passes before Philip responds.]

It’s taken my nephew, cousin, and another friend in my village. It also has me by the throat. That’s the image I have.

PROVIDER: [Anthony nods.] It’s cutting off your breath. [Philip nods, and then more silence].

PHILIP: I want to find my way back.

PROVIDER: Back to?

PHILIP: To my life, my way of life, to my family.

[Pause.] I’m missing seasonal camp now.

PROVIDER: How do you see doing this?

PHILIP: Got to face the evil spirits. And got to give back the White man’s poison.

PROVIDER: Any thoughts on how to do this?

[Philip shakes his head no.] Do you want to know

how we might do that here? [Philip nods. Anthony then uses the remainder of the session to talk about the Alaska Native services after detoxifica- tion and then potential housing opportunities after treatment, if Philip does not return to his village.]

PHILIP: [Humorously.] I guess I am here for more than three hots and a cot. I heard the food wasn’t that good anyway. [Philip agrees to the next steps but worries that he will feel trapped. To conclude, they develop a plan for how Philip can alert others when he is feeling trapped. At the end of detoxifi- cation, he moves to inpatient and keeps Anthony as his provider.]